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Surgical outcomes of medically failed prolactinomas: a systematic review and meta-analysis

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Abstract

Purpose

In Prolactinomas, surgery or radiation are reserved for DA failure due to tumor resistance, intolerance to medication-induced side-effects, or patient preference. This systematic review and meta-analysis summarizes the currently available literature regarding the effectiveness of surgery to treat prolactinomas in patients who have failed DA therapy.

Method

A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that reported outcomes of medically resistant and intolerant prolactinoma treated surgically.

Results

10 articles (Total N = 816, Surgery N = 657) met the inclusion criteria. 38% of patients who underwent surgery following DA failure achieved remission without need for further treatment (p < 0.001, I2 = 67.09%) with a median follow-up of 49.2 +/− 40 months. 62% achieved remission with multimodal treatment (p < 0.001, I2 = 93.28%) with a median follow-up of 53 +/- 39.8 months. 16% of cases demonstrated recurrence after early remission (p = 0.02, I2 = 62.91%) with recurrence occurring on average at 27 +/- 9 months. Overall, 46% of patients required reinstitution of postoperative DA therapy at last follow up (p < 0.001, I2 = 82.57%). Subgroup analysis of macroprolactinoma and microprolactinoma has demonstrated that there is no statistical significance in achieving long-term remission with surgery stand-alone in macroprolactinoma group (p = 0.49) although 43% of patients were able to achieve remission with multimodal therapy at last follow-up in the same group (p < 0.001, I2 = 86.34%).

Conclusions

This systematic review and meta-analysis revealed 38% of operated patients achieved remission, while 62% achieved remission when additional modes of therapy were implemented. Therefore, although surgery has not been initial therapeutic choice for prolactinoma, it plays a significant role in medically failed prolactinoma care.

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Authors and Affiliations

  1. Department of Neurological Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA

    Karan J. Yagnik, John L. D. Atkinson, Maria Peris-Celda & Jamie J. Van Gompel

  2. Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA

    Garret Choby & Jamie J. Van Gompel

  3. Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA

    Dana Erickson & Irina Bancos

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  1. Karan J. Yagnik
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Contributions

KJY—Conception and study design, data collection, data analysis, writing an original draft. DE, IB, JLDA, GC, MPC—Conception and study design, critically revising draft. JVG—Study supervision, conception and study design, critically revising draft, approving final version of draft.

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Correspondence to Jamie J. Van Gompel.

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Yagnik, K.J., Erickson, D., Bancos, I. et al. Surgical outcomes of medically failed prolactinomas: a systematic review and meta-analysis. Pituitary 24, 978–988 (2021). https://doi.org/10.1007/s11102-021-01188-7

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